Headache and Migraine Treatment Prescribing Trends

According to results of a retrospective study presented at PAINWeek 2017, opioids are not only prescribed to a large proportion of patients diagnosed with headache (H) and/or migraine (M), but are also more commonly used than triptan medications.

During the analysis, 547,558 adults with at least two ICD-9-CM or ICD-10-CM diagnostic code claims for H or M were identified in the HealthCore Integrated Research Database. Analysis included the demographics, comorbidities, and prescription medication use of these patients, as well as the proportion of days covered (PDC) ≥80% and persistence (no gap of ≥30 days in preventive medication supply).

The 5 mutually exclusive cohorts were H only (n=365,091), M only (n=94,492), H/M on the same day (H/M, n=7,461), H then M (H-M, n=46,656) and M then H (M-H, n=33,858).

The study authors reported, “Approximately 11% of patients with a first diagnosis of H had a subsequent M diagnosis, and 25% of patients with a first diagnosis of M had a subsequent H diagnosis.” The median time found between diagnoses was 231 days for the H-M group compared to 252 days for the M-H group. Additionally, patients in the H only group were found to have a higher rate of vascular comorbidities, such as hypertension/dyslipidemia, ischemic heart disease, and cerebrovascular disease, compared to the other cohorts.

Medication use was also found to vary among patients in different cohorts. Results of the study found that only 4% of H only patients used triptan medications compared to 46–50% of patients in the other 4 groups. The study authors reported, “Opioid use was fairly high in all groups [H (61%), M (57%), H/M (74%), H-M (71%) and M-H (74%)].” They added, “Triptan and opioid use between diagnoses among H-M was 18% and 56%, respectively, and among M-H 38% and 56%, respectively.”

Preventive medication use data obtained during the study was also reported. It was found that 47% of H patients, 49% of M patients, 65% of H/M patients, 69% of H-M patients, and 68% of M-H patients had ≥1 preventive medication prescription after last diagnosis. Top preventive medication choices included ACE inhibitors for H patients (18%), beta-blockers for M patients (17%), and antiepileptics for H/M, H-M, and M-H patients (31%, 33%, and 33%, respectively).

The study authors also found that the proportion of patients, respectively, with PDC ≥80% and persistent to preventive medications following final diagnosis was low [H (22%, 2%), M (20%, 2%), H/M (13%,2%), H-M (16%, 1%) and M-H (17%, 3%)].

Opioid prescribing is very common among patients diagnosed with H or M. Because preventive medication use varies substantially and medication adherence is low, therapy for patients diagnosed with H and M should be optimized.

Reference

Morrow PA, Chung H, Visaria J, et al. Medication Use among Patients Diagnosed with Headache and Migraine in a Large National Commercial Database: A Retrospective Study. Eli Lilly and Company. Indianapolis, IN, USA.